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A Home-based Functional Hand-Extremity

Assessment System for Stroke Rehabilitation

Tri Vu1 , Hoan Tran1 , Feng Lin1 , Jeanne Langan2 , Lora Cavuoto3 , and Wenyao Xu1
Department of Computer Science and Engineering, SUNY at Buffalo, Buffalo, NY, 14260
Department of Rehabilitation Science, SUNY at Buffalo, Buffalo, NY, 14260
Department of Industrial and Systems Engineering, SUNY at Buffalo, Buffalo, NY, 14260
Email: {trivu, hdtran, flin28, jlangan, loracavu, wenyaoxu}@buffalo.edu

Abstract—This paper presents a novel hand-grip system for employs two main components: the hand dynamometers as
evaluation and rehabilitation of individuals with stroke. This force sensors for hand grip and the LabVIEW VI program for
system contains a pair of hand dynamometers, which are sensors visual display and data collection. It is capable of generating a
for the input of grip force, and LabVIEW VI software to
translate the grip force into meaningful data. The hand-grip quantitative analysis which manifests and interprets the results
system requires the subjects to move a small ball on a computer from the grip tasks. The level of detail in the results displayed
screen toward a target, using the hand grip sensor to control the can be tailored to the clinician or patient as appropriate.
movement of the ball. It goes far beyond measuring maximum
grip strength, a common clinical assessment, to adapt grip force II. D ESIGN C ONSIDERATION
and coordinate hands to perform daily functional activities. This
Many existing system lacks comprehensive analysis of
system also provides advancement in home-rehabilitation options
to improve the hand-grip control of individuals with stroke. functional coordination between hands. In our system, we
employed a pair of hand dynamometers to gain insight of
I. I NTRODUCTION bilateral coordination, as well as grip strength. The exercises
The ability to modulate grip is a key component in per- are designed so that patients can either work unilaterally
forming daily functional activities such as brushing our teeth, or bilaterally, precisely coordinating grip strength between
opening medicine bottles, or placing groceries in the refriger- hands. The magnitude of grip necessary to reach a target
ator. Following stroke, hand manipulation is reduced in speed is scaled to the participant’s ability, making it possible for
and accuracy [1]. Grip strength and coordination has a direct participants with low grip strength to perform the exercise.
relationship with motor abilities in individuals recovering from LabVIEW VI software is used for the user interface. The
stroke. There is robust evidence showing the value of grip system is designed to be user friendly with an emphasis
strength as a clinical assessment. The correlation between both on being simple and intuitive. We are currently focusing on
maximal and sustainable grip, and ability to perform functional feedback that is appropriate for the individual with stroke.
tasks emphasizes the need to maximize grip through rehabilita- Further analysis with greater detail will be part of future data
tion [2]. Moreover, the ratio of paretic to non-paretic maximal reports appropriate for clinicians.
hand grip strength is a predictor of upper extremity outcome
following stroke [3]. These simple assessments of hand grip
susustainability and maximal strength have been shown to be A. System Overview
valuable outcome measures in stroke rehabilitation. The system consists of two main parts: the hardware sensors
However, the current use of grip strength in both assess- and the software program design. The hardware part contains a
ments and training are not comprehensive enough. They pri- pair of force sensors positioned upright in front of participants.
marily address maximal voluntary grip force and sustainability Theses signals are generated by the hand grip force of the
of grip, while neglecting aspects of coordination between participant. In the next step, the analog signals are assigned
hands or modulating grip appropriately for a task. More as the coordinates of the controlled object (a ball) in the
elaborate systems,such as the Biometrics E-LINK EP9 Ex- interface, equivalent to moving the object accordingly. The
ercise and Evaluation System, include the use of electromyo- data of coordinates and time are recorded for post-analysis by
graphy (EMG) requiring more assistance from rehabilitation MATLAB. It will be assessed based on our proposed features
professionals. This system still lacks bilateral activities [4]. which give us insight into the subject’s motor performance.
Other systems such as the QM-FOrMS does include bilateral As such, the system is expected to be valuable as both an
rehabilitation but not the grip control [5]. assessment and rehabilitation tool. The overview flowchart of
To address these problems, in this paper, we propose a the system is demonstrated in Fig. 1.
comprehensive solution of constructing a hand grip strength
and coordination evaluation/rehabilitation system with cost B. Handgrip Control Console with Sensors
effective assessments that may also be used in rehabilita- The pair of hand dynamometers utilized the Vernier HD-
tion to improve grip function in individuals post stroke. It BTA [6], shown in Fig. 1. It is capable of sensing grip and
Fig. 1. The framework overview of the hand grip evaluation system.

pinch force between the range of 0-600N. The forces are indicating the path of the ball over time as illustrated in Fig.
converted into voltage by the strain-gauge based isometric 3. When the ball reaches the target, the trial ends, and the
sensors inside the sensors [6]. The pair is wired to the National system stops registering data. The result is written into a file
Instrument NI USB-6009 data acquisition (DAQ) for Analog- for further analyses using MATLAB.
to-Digital conversion [7].
For the display of interface and hardware interaction, we
employ two models of laptops, the Acer E5-571 with 15.6 inch
in screen and the Microsoft Surface Pro 4 with 12.3 inch in
screen as demonstrated in Fig. 2. LabVIEW VI is programmed
to be compatible in all types of laptops and PCs making it
straightforward to install for a home program. The purpose
of utilizing a variety of models is to validate the home-based
characteristics and universal compatibility of the system.

Fig. 3. An example exercise in the VI. In this exercise, the target reached
and the trial stops. Main components: (1) ”Run” button, (2) size calibration,
(3) movement display and (4) sensitivity calibration.
Our system is designed to engage the user and assess motor
performance. It will have the capacity to store data and track
progress over time. This system, including data output, is
valuable to clinicians guiding care and individuals with stroke
using the unit and to improve their motor control. The design
is straightforward to be easily understood and yet be engaging
Fig. 2. System setup for an experiment with a stroke patient. The Microsoft to individuals using it to improve hand function.
Surface Pro 4 is employed for interface display and monitor in this trial.
C. Rehabilitation Program Design [1] A. Heller, D. Wade, V. A. Wood, A. Sunderland, R. L. Hewer, and
The rehabilitation program is programmed in LabVIEW E. Ward, “Arm function after stroke: measurement and recovery over the
first three months.” Journal of Neurology, Neurosurgery & Psychiatry,
which receives the pressure digital signals from the National vol. 50, no. 6, pp. 714–719, 1987.
Instrument DAQ, which is translated to the position of the red [2] T. Kamimura and Y. Ikuta, “Evaluation of sustained grip strength for a
ball, as presented in Fig. 3. The size bars on the left side and stroke patient with a mild paresis.” Hiroshima journal of medical sciences,
vol. 51, no. 1, pp. 23–31, 2002.
the sensitivity selection on the right side provides calibration [3] P. Boissy, D. Bourbonnais, M. M. Carlotti, D. Gravel, and B. A. Arsenault,
parameters for the size of the object and the target as well as “Maximal grip force in chronic stroke subjects and its relationship to
the rate of movement depending on the participant’s ability to global upper extremity function,” Clinical Rehabilitation, vol. 13, no. 4,
pp. 354–362, 1999.
generate and sustain grip force. [4] D. Allen and F. Barnett, “Reliability and validity of an electronic dy-
The exercise will begin when we hit the ”Run” button. namometer for measuring grip strength,” International Journal of Therapy
Squeezing the left dynamometer will make the red ball move and Rehabilitation, vol. 18, no. 5, p. 258, 2011.
[5] F. Lin, J. Ajay, J. Langan, L. Cavuoto, I. Nwogu, H. Subryan, and W. Xu,
up the vertical axis, while releasing the force will drop it down. “A portable and cost-effective upper extremity rehabilitation system for
Similarly for the horizontal axis, applying force to the right individuals with upper limb motor deficits,” in 2016 IEEE Wireless Health
dynamometer will cause the ball to go right and decreasing (WH), Oct 2016, pp. 1–7.
[6] V. HD-BTA. (2017, march) Hand dynamometer. [Online]. Available:
the amount of force will make the ball move to the left. When https://www.vernier.com/files/manuals/hd-bta/hd-bta.pdf
no pressure is exerted to either dynamometer, the ball will be [7] N. Instrument. (2017, march) Ni usb-6009. [Online]. Available:
in the original position. The system can draw a traced line, http://www.ni.com/pdf/manuals/375296a.pdf